Objectives To analyse the effect of the reduction of sickness absence compensation, implemented by law on 1^st of July 2009, on use of sick-days in employee groups with different education level.

Methods Data from a nationwide survey “Health Behaviour among Estonian Adult Population” in 2004, 2006, 2008 and 2010 was used. Proportions of sickness absence usage and selected descriptive variables were analysed in two population groups: lower ( ≤12 years of education) and higher educated (≥13 years of education) employees. The difference in use of sick-days before and after the reform was assessed using the chi-squared test.

Results The dataset comprised 7918 employed persons between 18–64 years of age. The overall decline of average sick-days per employee was 21%, from 9.1 to 7.2 days. Decline of the sickness absence users’ proportion was significant in both education groups: from 47% to 40% (p = 0.002) in lower and form 44% to 38% (p<0.001) in the higher education group. For lower educated employees the drop was significant in the age group over 50 years (14% vs 11%, p = 0.049) and the users of 1–14 sick-days per year accounted for the decline. For higher educated employees the decline was observed in the age group under 50 years.

The only increase in the use of sick-days was observed (24% vs 30%, p < 0.001) in higher educated employees with higher income.

Conclusions There was a considerable decline in the use of sick-days after the reform, but some employee groups may need more attention to preserve their workability. The decline of sickness leave use among older persons and lower use of short sickness absences by lower educated employees may indicate their uncertainty in the labour market. In the group of higher educated persons with higher income the increased use of sick-days may reflect increasing psychological demands and related health deterioration.